Haiti’s Disaster after the Disaster: The IDP Camps and Cholera

January 12, 2010 will forever be remembered as one of the world’s deadliest disasters. For thirty-five seconds the earth shook and reduced a nation – already struggling with the weight of slavery, underdevelopment, imperialism, and intense internal divisions—to rubble. A conservative estimate of 1.5 million people – one in six people in Haiti – lost their homes, while an estimated 300,000 people lost their lives. The National Palace and the surrounding area – housing most of Haiti’s government offices – were almost completely destroyed. In addition to the physical damage suffered, the government lost an estimated 17 percent of its workforce in the temblor.

The world responded with one of the most generous outpourings of aid in recent history. By March 1st, private citizens in the U.S. alone – one in two people – donated $1 billion for the relief effort, of a total of $2.2 billion in the first two months (Katz 2010a). At a donors’ conference on March 31 in New York, international agencies pledged $5.3 billion over the next eighteen months. This donors’ conference also ratified an Interim Haiti Reconstruction Commission (CIRH, in the French acronym), with U.N. Special Envoy Bill Clinton and Prime Minister Max Bellerive as co-chairs.

Despite this effort, surprisingly little has reached Haiti’s most vulnerable living in the internally displaced persons (IDP) camps. In July, six months following the earthquake, the CNN reported that only 2 percent of the pledged aid had arrived (CNN 2010). Other agencies – including Clinton – have placed the figure at ten percent, but the only funds accounted for are those going through the Haiti Reconstruction Fund, run by the foreign-dominated CIRH.[1] Even with this, very little of the aid is going to the Haitian government. According to the AP, 33 percent of aid went to the U.S. military, while less than 1 percent went to the Haitian government (Edmonds 2010). As of the beginning of April, the U.S. Red Cross collected $255 million but only allocated $106 million to Haiti (Edmonds 2010). Of the funding that was sent to Haiti much of it was overhead.

More than mere embarrassments, these failures constitute violations of the human rights of the 1.5 million people living in the camps (the latest tracking mechanism on September 14 from the International Organization of Migration, OIM in French, actually lists 1.3 million people and an additional 200,000 using the services). The U.N.’s Office for Coordination for Humanitarian Affairs (OCHA) presented Guiding Principles for Internally Displacement in 1998, ratified in 2005 by U.N. member states. It provides some legal framework for IDP rights, including:

In addition to these Guiding Principles, the Spheres Project (www.spheres.org) coordinated a series of humanitarian actors and established the Humanitarian Charter and Minimum Standards. While self-governed and policed, these are supposedly minimum standards to which all humanitarian agencies are to adhere following a natural disaster. The first, Common Standard, mandates community participation: “The disaster-affected population actively participates in the assessment, design, implementation, monitoring and evaluation of the assistance program.” Other relevant standards are that “all people have safe and equitable access to a sufficient quantity of water for drinking, cooking, and personal and domestic hygiene. Public water points are sufficiently close to households to enable use of the minimum water requirement,” noting the average water use is 15 liters per person per day. Another minimum standard the humanitarian community set for itself is a maximum of 20 people use each toilet.

The legal enforceability of the above remains tenuous, which is why they are referred to as “guidelines” or “minimum standards.” There are, however, more specifically delineated rights, such as the Haitian Constitution 22 that “the State recognizes the right of every citizen to decent housing, education, food, and social security.”[2] True, the Haitian state – weakened by decades of neoliberalism – was devastated following the earthquake; many government buildings and an estimated 18 percent of the employees died. That said, however, there is a growing consensus that rebuilding Haiti will require working with the government and not just NGOs, as noted below. Also noted below, segments within Haiti’s national and local governments are often the most active in problem solving.

Unfortunately, crowding out this discourse on human rights is another, reactionary refrain used to justify inaction. It is true that, as a result of the uncoordinated, top-down approach to food distribution, cases were documented wherein families sent members to different camps to maximize their chances to get food (INURED 2010). However, nearly all NGO and international agency staff argue that people only stay in camps in order to receive services. This narrative has carried weight, cited by members of the U.S. Congress as justification for delay sending the 1.15 billion in pledged aid.

This discussion has lethal consequences, as vital aid is not making its way to the ground. For example, seven months following the earthquake, 40 percent of IDP camps do not have access to water, and 30 percent do not have toilets of any kind. An estimated 10 percent of families have a tent; the rest sleep under tarps or even bed sheets. In the midst of hurricane season with torrential rains and heavy winds a regular occurrence, many of the tents are ripped beyond repair. Only a fifth of camps have education, health care, or psycho-social facilities on site.

Teams of evaluators have completed physical inspections of most of the housing stock in Port-au-Prince, tagging the house in different colors, according to their habitability. “Green houses” – fit for human habitation – have become very valuable; according to U.N. staff, rent for “green houses” have gone up 300 percent. This makes “moving back” out of the camps out of reach of most residents, as an estimated 70 to 85 percent of Port-au-Prince residents did not own their home before the earthquake. Most people who thus remain in the camps, enduring the torrential rain and wind as they batter the tents and the resulting pools of mud and standing water that attract disease vectors, do so because they have no option. They are stuck, literally in the mud.

For many other residents still traumatized by losing their families, their worldly possessions, and their homes, the issue is whether or how to move back to homes that have sustained damage. Many are still afraid to sleep under concrete. The question is how to tell whether damaged homes are repairable or whether the foundations are fundamentally unsound. The Public Works teams have color coded these “yellow” or “red” houses. Also an open question is whether or how homeowners will obtain the resources to rebuild, especially given the lack of funds.

Even a cursory visit to the majority of IDP camps yields the inescapable conclusion that despite the promises and the best efforts of humanitarian actors, much more must be done. Like the thousands who are contemplating moving back into their damaged homes, we need to ask, are people just falling through the cracks, or is the foundation itself unsound?

The evidence systematically collected and analyzed in this report argues the latter. Following the analysis are recommendations to fix the system before it is too late. Prudence – not to mention justice – demands that we not wait til the next disaster to act.

Background

On February 28, an earthquake measuring 8.8 on the Richter scale ripped through Chile, causing hundreds of deaths. While random chance intervened, placing Haiti’s earthquake along a newly-discovered fault (Israel 2010) right by Haiti’s population center, most of the difference lies in Haiti’s heightened vulnerability to disasters.

While it is absolutely true that Chile, like the U.S., has its share of poverty and inequality, Haiti’s development indicators are and were much worse than Chile’s. For example, Haiti’s Gross Domestic Product (GDP, total value of goods and services) per person was $428 in 2005, while Chile’s per capita GDP was $8,350 in 2007. Half of Haiti’s people earn $1 per day or less, whereas only 2 percent of Chile’s citizens live under the “international poverty line” of $1.25 per day. The latest figures for child mortality are instructive: 74 children out of 1,000 die in Haiti whereas only 9 do in Chile. For all these reasons, Haiti ranked 149th out of 182 countries on the U.N.’s Human Development Index (HDI), whereas Chile ranked 44th. Haiti is the least developed country in the Americas, while Chile shares a ranking with central Europe. See Oliver-Smith (2010) for further discussion of the construction of Haiti’s vulnerability.

For an even clearer example, on September 4, a quake of similar magnitude (7.1) flattened buildings in Canterbury, New Zealand, with no earthquake-related deaths (Dykstra 2010).

In addition to Haiti’s poverty, the earthquake was rendered more deadly because of the rapid and anarchic urbanization since the 1980s. According to Alex Dupuy (2010), Port-au-Prince grew from 150,000 in 1950, to 732,000 in the early 1980s, to approximately 3 million people in 2008. Why did the population of Port-au-Prince increase fourfold since the mid-1980s? First, the United States Agency for International Development (USAID) demanded that Haitian dictator Jean-Claude Duvalier kill off the entire indigenous pig population following a 1978 outbreak of swine fever (now after recent events known as H1N1). Haitian pigs required relatively little maintenance but could be sold to pay for schooling, medical expenses, and a range of economic goods. They were de-facto bank accounts for the rural population (Diederich 1985), so their genocide represented Haiti’s “great stock market crash” (Smith 2001:29). Their livelihood annihilated,[3] many peasants migrated to the cities. Haitian economist and director of research for Haiti’s State University (UEH) Fritz Deshommes estimated that neoliberal policies destroyed 800,000 agricultural jobs (Bergan and Schuller 2009). In addition to neoliberalism’s “push” factors, it provided several “pull” factors, most notably the siren song of low-wage factory jobs in Haiti’s offshore apparel industry (DeWind and Kinley III 1988). Duvalier boasted that with his collaboration with the World Bank, USAID, and other donors, Haiti would become the “Taiwan of the Caribbean.”

So where were newly landless peasants going to live, including those lucky enough to find a job for about $2 per day in the factories? Port-au-Prince’s bidonvil­, its shantytowns, were born. Since neoliberal policies, particularly lending institutions’ Structural Adjustment Programs, cut what little public spending there was for education and health care, people – particularly women heads of households – had to use their meager earnings to fulfill these basic needs. So people saved money where they could, many living on a seven-by-seven foot patch of land on which they were responsible for building a house, tomblike structures in neighborhoods where there no government investment in water, street maintenance and cleaning, or electricity. All of these factors – direct outcomes of neoliberal policies – exacerbated Haiti’s vulnerability and added to the death toll.

In short, Haiti’s earthquake was rendered more deadly by the implantation and continual application of neoliberalism, the so-called “Washington Consensus” that donor groups like the World Bank, the Inter-American Development Bank, and USAID imposed on countries in the Global South like Haiti. The earthquake could have provided an opportunity for rethinking the economic model, with Bill Clinton famously apologizing for the promotion of subsidized Arkansas rice to the Senate Foreign Relations Committee on March 10: “It may have been good for some of my farmers in Arkansas, but it has not worked. It was a mistake. I had to live everyday with the consequences of the loss of capacity to produce a rice crop in Haiti to feed those people because of what I did; nobody else.”

NGO-ization

One major plank in neoliberalism is a distrust of states and a preference for private-sector initiatives and the elusive concept of “civil society.” Since the 1980s, NGOs have proliferated in Haiti and elsewhere. The 1990s saw a tenfold increase in their numbers, from 6,000 worldwide in 1990 to an estimated 60,000 by 1998 (Economist, cited in Regan 2003:3). Currently, there are so many NGOs that we can’t even guess at their number (Riddell 2007:53). This rise in the number of NGOs is matched with an increase in funding through them. Globally, in 2005, it is estimated that NGOs channeled anywhere from 3.7 to 7.8 billion U.S. dollars of “humanitarian assistance” (Development Initiatives 2006:47), and 24 billion in overall development funding (Riddell 2007:259).

The pattern is true in Haiti, with only 74 NGOs out of an official count of 343 in 2006 being present before the dechoukaj, before the ouster of foreign-supported dictator Jean-Claude Duvalier (Schuller 2007). Since the Dole Amendment in 1995, all of USAID funds go through NGOs. A senior U.N. official recently estimated that for all donors 98 percent of aid goes directly to NGOs. Haitian researcher Sauveur Pierre Étienne called this situation an “Invasion” (1997). All this is to say, whereas NGOs may not have created this neoliberal framework, they accepted an infusion of official government aid – known in the field as “Overseas Development Assistance.” Like it or not, the fact that NGOs accepted and continue to seek out more of this aid – and benefit by receiving ever-greater amounts – to preside over the development system makes NGOs accountable for its clear failure in Haiti.

Bill Clinton has repeatedly said that there are 10,000 NGOs working in Haiti, which would make the most NGOs per capita, one for every 900 people. While it is unclear how he arrived at this number, it is likely that he added up the associations and local groups registered with the various ministries. For example 6,000 groups were registered with the Ministry of Social Affairs and Work (MAST). Student assistants in the summer of 2009 received a copy of this list for a Port-au-Prince neighborhood. Of the 65 groups listed, only 2 still existed. Looking at the timing of the founding of the agencies, and discussing with neighborhood leaders, suggests that they were created to carry out NGO projects. Once the project ended, so did the association.

Whether one adopts the official statistic put out by the Minister of Planning and Foreign Cooperation (MPCE) or Clinton’s estimate of 10,000 NGOs, a central issue within the NGO system is coordination. According to MPCE staff, on any given year, only 10-20% of NGOs submit their annual report to the government, despite it being a requirement to function in the country. Since the 1980s through 2009, almost every report commissioned by donors, government of Haiti, NGOs, or independent researchers, on NGOs concludes with a recommendation that NGOs need to do a better job coordinating with one another, and the government needs to set a framework that NGOs will work under, to avoid duplication of services and gaps and to ensure that local development priorities are being implemented.

The fact that for almost 30 years researchers from across the political spectrum make the same recommendations suggests that NGOs continue to act on their own. Many in Haiti call NGOs “parallel states” or “states within the state” or simply “fiefdoms” because of their tendency toward isolation and near total control over geographical regions. Further, NGOs directly drain the capacity of the state by paying much higher salaries – many people estimate three times greater – what World Bank researcher Alice Morton termed “raiding” (1997:25). The social and economic distance that NGOs, the backbone of Haiti’s middle class, are expressed in popular distrust of NGOs as a structure. Some, playing on the self-named “political class” are beginning to discuss Haiti’s “NGO class” that move from one job to another, driving the newest and biggest cars, etc. (Schuller 2009).

Again, like with the case for neoliberalism and its destruction of the local economy, the earthquake presented an opportunity to rethink the approach to working with NGOs (Kristoff 2010). Clinton even said that it was a mistake to work outside of the Haitian government, creating parallel structures that are unaccountable. “Every time we spend a dollar in Haiti from now on we have to ask ourselves, ‘Does this have a long-term return? Are we helping them become more self-sufficient? … Are we serious about working ourselves out of a job?’”

Methodology

To begin the selection of camps to analyze, the latest OIM’s “Displaced Tracking Matrix” (DTM) spreadsheet was used. On the Cluster for Camp Coordination and Management (CCCM) website, run by OIM, the latest database[4] was dated May 3, with 1282 sites overall and 841 within the Port-au-Prince metropolitan area. Every eighth camp was selected for inclusion into this research.

Significantly, several camps were closed by May 3, and many more by July 7, when the DTM was updated. 42 camps were noted as “closed” on the May 3rd DTM, with 8 on the random sample. Disturbingly, an additional 19 camps (18%) were closed in the following two months. In order to maintain the scientific verifiability, to make up for the loss of the 27 closed camps, a random sample of the July 7th DTM (861) was employed, one out of every 32 camps. In case of duplication the following camp was used.

Assistants went to the field with a three-part survey in their hand, the first investigating the conditions and services, the second asking a sample of four people their level of knowledge and involvement in the committees, and the third interviewing committees. Especially during surveys of small camps it was difficult if not impossible to interview four people by themselves, without the watchful eye of committee members that would have influenced the data. In these cases only two people were selected. For quality control purposes, the author had three camps analyzed by two different assistants. In addition, the author followed up with at least one site visit per assistant. In several instances residents themselves invited the author – a foreign researcher – to discuss the situation and document conditions. The author visited 31 IDP camps.

In the data analysis, to explore patterns in the gaps within services and to verify several hypotheses several variables were designated as independent. In addition to the simple frequency, data were cross-tabulated with the following independent variables: land ownership, size of the camp, commune (city), the presence of an NGO camp management agency, and majority of women committee members.

Physical Conditions in the Camps

One is immediately struck by the physical conditions inside the camps, particularly following a rainstorm (unfortunately quite a common occurrence in the summer months). Without exception (n = 31) sanitation and drainage for rainwater was a serious issue. On the morning following a rainstorm it is common to find large pools of standing, muddy water – often stretching 20 yards – over which mosquitoes, flies, and other potential disease vectors circle overhead. In at least one camp, Noailles, the researcher estimated that almost all the children had a rash on their bodies because of the heat that is trapped inside the tents combined with the other disease vectors. The author himself contracted a rash following repeated exposure to these unsanitary conditions.

Bracketing the health consequences, this lack of proper drainage and sanitation still represents serious environmental hazards, most notably the smell. Even in camps with latrines, the standing rainwater and mud is pungent, reminiscent of pig farms. Often, documented by research assistants and the author, the mud seeps underneath people’s tents or tarps, rendering it impossible to sleep or keep personal effects – such as voter ID cards, birth certificates, marriage licenses and memorabilia such as photos – dry and intact. “It is also impossible to sleep when the mud seeps in. Imagine; everything around you moves,” said one resident.

Sanitation

People staying at or near their houses and not inside one of the eight hundred camps within the capital do not have to contend with the problems associated with sharing a bathroom with neighbors. At even the best managed camps, this is a widespread concern. The Sphere minimum standards – recently translated into Haitian Creole[5] – outline two ways to address this sharing: facilities are either sex-segregated or shared by household. The author only encountered two camps with sex-segregated toilets, and these were both very large camps, planned re-settlements. The lack of gender-segregated facilities poses serious problems, particularly for women.

Carine Exantus, a FASCH (Social Sciences) college student and author of a blog[6] reporting from the camp in Champs-de-Mars across the National Palace, recalled in an interview:

In my camp, there are 12 toilets in the front, 12 toilets in the back for 4,200 people. In the camp, the shower is… Everyone at their tent has a little plastic basin, where they throw water over themselves, or they just shower in public. They put water in their basin and they bathe like that, there are many young men and women who do it that way. In my journal I wrote about this; young women suffer sexual aggression because they have to take showers in public.[7]

The Minimum Standards are also clear about how many people should share a toilet: no more than 20. It is clear from Carine’s testimony that these conditions are not even being met right in front of the National Palace, where foreign NGOs, dignitaries such as former U.S. presidents, and journalists visit. The toilets line the outside of the camp, presenting the appearance of plenty. Hidden from passersby’s view are rows and rows of tarps and tents.

And this is in a camp that is relatively well taken care of. Away from the glaring gaze of foreigners there are camps that are far worse off. In Place de la Paix (Peace Plaza), in the Delmas 2 neighborhood, also lining the perimeter, there was a row of toilets next to the trash receptacles, which was next to the water distribution and the site for the mobile clinic. Strikingly, there were only 30 toilets for 30,400 people. According to the latest DTM, 6,820 people live in the soccer field outside of the rectory in Solino. Despite this density, residents had to wait for almost five months for the first toilets to arrive. When asked how people defecate, a resident held up a small plastic bag usually used to sell half cups of sugar, or penny candy. “We throw it in the ravine across the street.” In the CAJIT camp, housing almost 2,500 people in a far-off neighborhood in Carrefour, there were no toilets – either portable or latrines – at least as of August 12, seven months following the earthquake.

These cases are unfortunately not isolated. According to even the most conservative estimates, with some large camps in which assistants had to estimate taken out of the sample, the average number of people sharing a toilet in the Port-au-Prince metropolitan area is 273 people. Thirty percent (27 out of 89) of camps with verified information did not have any toilets at all. Another investigation found similar results, that 27 percent of families had to defecate in a plastic container or an open area (The LAMP for Haiti Foundation, et al. 2010). This data was seven months following the earthquake, despite the persistent narrative that people are swelling the camps – or ‘faking it,’ just using the camps during the daytime – primarily in search of services.

For the camps with services, the most common are latrines, pit toilets with a hole dug in the ground (35, or 62.5 percent), followed by plastic portable toilets (19, or 34.0%). In a small minority of camps (2, or 3.6%), residents had access to flush toilets. Installing toilets is one of the most important services provided by NGOs. Unfortunately residents’ needs don’t stop with their installation, and many are not cleaned on a regular basis. While 25 camps report that their toilets are cleaned every day (37 percent – mostly those with portable toilets), 10 camps (15%) report that they are cleaned less often than once per month, and 17 (25%) report not having the toilets cleaned at all. “They treat us like animals!” said an exasperated resident. She was interrupted by a neighbor: “worse! Animals live better than us.” Some members of the WASH (Water and Sanitation) cluster are frustrated at what they see as the irresponsibility of NGOs: “We call and call and write report after report. Some just flatly ignore us.”

Water

In addition to sanitation, arguably even more important, is the provision of safe, clean, water. In several reports the UN highlights the distribution of water to 1.2 million people (Ban 2010) as a success of the ensemble of agencies and NGOs. Like sanitation, there are still – as of seven months following the earthquake – large gaps in water distribution to IDP camps.

Take for example the case of Bobin, in a ravine outside of Pétion-ville, in a popular neighborhood off of Route des Frères. As of seven months following the earthquake, the 2,775 residents (according to the DTM, there were 1,591 people) still had no water. A single PVC pipe that had cracked offers some people a couple of buckets whenever the government turns on the tap for paying clients. Many people use the rainwater in the trash-filled ravine. Some individuals had the opportunity to fetch water from a nearby tap, either privately owned or at a nearby camp. Residents mentioned that NGOs had talked about installing a water system but seven months after the earthquake, it still had yet to materialize. According to Valerie Kaussen who investigated the situation, most of the problem lies in the fact that two NGOs, Solidarité and World Vision International, had begun WASH projects, and so World Vision got out of the camp. Months later, at the end of September, following advocacy from Kaussen and the report author, progress was finally made in Bobin.

Several other camps, particularly in Cité Soleil and CAJIT in the hills above Carrefour noted above, were without water as the research team investigated. Said Olga Ulysse, CAJIT leader, “Carrefour is blessed with many little springs. But the problem is that they are running under the destroyed houses and the decomposing bodies. It’s very unhealthy, yes. But we don’t have any choice at all.” The other choice is to walk downhill to the adjacent camp, pay for a bucket of water, and carry it back up the hill.

Of the camps wherein assistants could obtain reliable information, 30 out of 71, or 40.5 percent, of camps did not have a water supply, and 3 others (4.1 percent) had a nearby PVC pipe that was tapped outside the camp. The human rights investigation cited above (LAMP et. al. 2010) noted similar results, that 44 percent of families drank untreated water. With the notable exception of the WASH cluster who distinguishes themselves with an activist, hands-on approach to filling the gaps in services, people from all levels of the aid industry repeated the refrain that providing life-saving necessities encourages dependency. Said one NGO worker, “people are only living in the camps in order to get the free services.” This discourse has wide currency in aid circles and foreign parliaments, including U.S. Congress. In addition to this issue, several commentators pointed to the issue of profit-making. According to a person who works at a foreign development agency, private water company owners persuaded Préval to stop free water distribution because it was cutting into their profits.

Healthcare

Given the very poor state of the healthcare sector before the earthquake, this sector overall has improved following the efforts of donors and NGOs coordinating with the Haitian government. Ground was recently broken on a new, large capacity teaching hospital in Mirebalais in partnership with Partners in Health / Zanmi Lasante and the Haitian government, approved by the Haiti Reconstruction Fund in their second meeting in August (Charles 2010). Within the flurry of news coverage marking the six month point, Clinton and others claimed success because of the lack of outbreaks of public health catastrophes which otherwise would be expected given the state of sanitation within the camps, notably malaria and cholera. Clinton and others pointed to the existence of mobile clinics and other vaccination programs to explain this success, without citing epidemiological research.

Indeed, there are several gaps within the coverage of health care facilities inside the IDP camps. Only one camp in five has any sort of clinic facility on-site. This number does not account for quality. For example, in one camp, Carradeux, a tent was provided by UNICEF that resembles a clinic, but it was completely empty: no medicines, no first aid supplies, and no nurse practitioners were present on researchers’ five visits to this camp. “I’m a nurse,” executive committee member Elvire Constant began. “But we don’t have the means to serve the population. I spoke on TV and radio, telling the minister of public health that there are nurses available, and the population is vast [24,161, according to the latest information]. … UNICEF knows the tent is here, but they have never come by, not even one day, to negotiate with us, to tell us whether it could be a mobile clinic or a health center.” Inside the camp a couple hundred meters, a tent from Save the Children whose purpose eluded everyone I asked was empty and ripped past the point of providing any shelter. Carradeux is an officially-managed, planned relocation site, and supposed to therefore be an example for others.

According to residents, the median walking distance to the nearest clinic was 20 minutes, with the mean being 27 minutes. Five camps are so isolated that residents told researchers that it takes 90 minutes to reach the nearest clinic. The same can be said of pharmacies. While in the earthquake’s immediate aftermath medications were given to residents free of charge, this practice stopped early on in most camps and neighborhoods. Nine out of 85 responses, ten percent, of camps had some form of a pharmacy on-site. The mean time to walk to the nearest pharmacy was 25 minutes, with the farthest being two hours.

Cholera

In late October, cholera appeared in Haiti. Given the conditions above – the lack of health care facilities but especially the lack of water and sanitation within the camps – the bacteria spread like wildfire. As of the submission of this article at the beginning of December, over 1,700 people have died as a result of this “disease of poverty” (Mukerjee 2010). The outbreak of cholera, the “disaster after the disaster” was all too predictable. First, even before the earthquake, 70 percent of Haitian people did not have regular access to treatable water (NYU Center for Human Rights et. al 2008). Of the half a billion in Inter-American Development Bank loans to Haiti that the U.S. blocked to Aristide’s Haiti ostensibly because of the contested 2000 Senatorial elections, much of the funds were to develop Haiti’s rural water system. The concentration of aid efforts and the continued neglect of Haiti’s rural sector are also culprits.

More damning, the most plausible hypothesis to date of how cholera – that hadn’t struck Haiti in a century – arrived is through Nepalese troops. The troops occupied a facility in the Artibonite that had a leaky sewage; three waves of cholera hit Nepal this year; the troops arrived in October; and the strain does not resemble Latin American strains but those of South Asia. This lit the tinderbox of pent-up frustration against the occupying forces that many in Haiti see as an insult to Haiti’s sovereignty.

Even if the allegations prove to be false, the success of the U.N.’s mission in Haiti depends on good relationships with Haitian partners based on trust and open communication. As noted above, Haiti has been victim to strings of broken promises and failed international interventions. And even if this hypothesis is disproven (none others have been proposed that as adequately explain the outbreak), the U.N. and NGOs have failed to deliver water and sanitation to all of the IDP camps in Port-au-Prince. The bacteria responsible for cholera is carried through human feces. When it enters the water table it is almost impossible to stop.

Cholera is the disaster after the disaster that many Haitian people and advocates have feared. And it was totally predictable.

Education

Under duress even before January 12, education remains in crisis, particularly for people living within the camps. Students were without schools for three months, as the government gave a deadline of April 5, the day after Easter, for schools to reopen. Most schools did not.[8] Even for schools that re-opened, many children do not have access to attend. In Haiti, even before the earthquake, schools were among families’ highest expense. Career popular educator and activist Reyneld Sanon estimated that, “in a good school, you can pay up to 20,000-25,000 Haitian gourdes ($500-625) per year per child” (Bergan and Schuller 2009). For schools of questionable quality, known as lekòl bòlèt (literally, “lottery school,” in other words, take your chances), tuition and fees for one child amounted to a third of Haiti’s minimum wage of 70 gourdes ($1.75) per day.[9] For those living in camps this problem was exacerbated. On top of this issue of funds in a devastated economy, people living in camps have the additional concern of the farther transport. One resident, a mother of three school-aged children, told that she didn’t send her children to schools because of the time and the expense in sending them to school: “It is three kous (routes) to get to school – 25 goud per person – and an hour and a half each way if there is traffic.” In the Corail camp, in the desert difficulties of transport are even worse. Corail is four kous to town, and at least an hour and a half with good traffic on public transport.

For all these reasons, building schools within the camps is a necessity if the 600,000 children living in camps are to have an education. “It is a crisis. We are setting ourselves up to lose a generation,” said a camp committee leader in Carrefour. Despite this, according to UN staff, the government issued a decree forbidding schools from being built within the camps. In addition to the very powerful refrain that providing services within camps would encourage people to stay in the camps indefinitely and hinder progress in rebuilding people’s houses, this person’s analysis was quite blunt: “In Haiti, schools are the most profitable industry.” While statistics are not available to verify the claim, the point is clear.

As is the effect. Only 21 camps (21 percent) had a school as part of its services. Said Samuel Rémy, one of 6,000 people displaced from the Saint Louis de Gonzague school around the April 5th deadline, “There are 3,000 children here. Don’t we pèp la (“the people,” poor majority) have a right to school as well?” Education is a right guaranteed by Article 32.1 in Haiti’s constitution. As the new school year approaches, IDPs have made education for their children a focus of mobilization, for example on Monday, September 13.

Condition of Tents

While many foreign policymakers suggest that Haiti’s poor majority are living better than they have before the earthquake, they are forgetting the simple reality that living under tents or tarps do not provide adequate shelter against the harsh Caribbean conditions of extremely hot sun, winds, and tropical rains. In some camps, half of the tents were ripped beyond repair because of the winds. Elvire Constant recalled, “The wind is crazy. Last night [early August] the wind blew for more than three hours straight. I woke up, got up on my knees and held the tent up, left and right so that the tent wouldn’t blow away with me. What’s more serious is the afternoon sun.” Elvire had to leave her tent because it was destroyed. She pointed to another, where we were standing right by the entrance to the camp, just recently shredded by that night’s winds. The tent was on the ground not more than ten days. In all the camps visited, at least the bottom portion of the tents were covered in mud. In at least one camp, Obama3, the majority of tents were ripped as of early August.

These are the people who have tents. Most people in the camps don’t even have a tent. Assistants estimated that only ten percent of families living in the camps have a tent. Human rights investigators noted that of the 58 families studied in six camps, 78 percent did not live in an enclosed area (LAMP et al., 2010). For example, in Delmas 2, in Place de la Paix (Peace Plaza), the vast majority slept under tarps, that were set up in a patchwork fashion to cover the plaza. Rare was an individual tent underneath this “roof” that still leaked when it rained. Berthe Israel, president of a twenty-year old association called Men Nan Men (Hand in Hand), said, “The tents we have are minimal. There’s probably 10 tents inside [for 6901 families per the DTM]. I don’t believe there are 50, at most. The vast majority is under tarps. I wonder, what if there’s a fire? The entire camp would go up in flames. How can these people save the 2-3 things they have?”

This is not merely an academic concern. The hurricane season is upon us; two years ago this month 793 people lost their lives following four tropical storms. The conditions are ripe for an even greater catastrophe given people’s housing situation. Luck and hope is not good social policy for avoiding disaster. Case in point: a storm on Friday, September 24 that was not connected to a tropical storm killed five and injured 50 (Delva 2010). On November 2, Hurricane Tomas, downgraded to a tropical storm, passed through the town of Léogâne that was almost totally destroyed following the earthquake, killing at least 20.

Added up together, the camp conditions are far inadequate, subhuman, and violations of human rights. We must do better.

Patterns in the Gaps in Services

Seen from above, in terms of abstracted statistics of numbers of people served – 4.3 million people were given food, 2.1 million people non-food items, and 1.2 million receive water on regular basis (UN Security General’s Report, September 1) – it appears that progress is being made.

Seen from below, from the residents, the situation looks quite different. For example, 173 people said that aid arrived – out of 324 people (53.4%), with 7 people reporting that they did not know. Put another way, four out of nine people (44.4%) said that no aid arrived whatsoever, in any form. A human rights investigation reported that 75 percent of families had a person who did not eat an entire day in the previous week. This was in July (LERN et al., 2010).

Of the aid that arrived, almost half (46.5%) stopped distribution in or before April – 3-4 months since the interviews – and more than a third (35.1%) stopped in or before March – 4-5 months in the past. That said, 31.7 percent of the aid – which includes water, food, first aid kits, tents, etc.[10] – was last distributed in July.

However if we are to improve the situation for the 1.3 million residents of the camps, we need to ask, are there patterns in terms of who is not being served, and why? Some camps are far better managed and served than others. There are patterns within the gaps in services that need to be addressed. In addition to the simple statistics listed above, correlations in the data were explored with a range of variables. Analysis of the data using SPSS yielded four differences in services: the presence of NGO camp management agencies, the municipality, the size of the camp, and ownership of the land on which the camps sit.

NGO Camp Managers

This is the most obvious difference, and thankfully so. Data shows that camps with NGO managers are far better serviced than camps without managers. This is as it should be; the primary role of camp managers is to assure and supervise service delivery. That said, as of the July 7 DTM database, only 20.8 percent of camps (171 of 822 listed in the metropolitan area) had an NGO management agency. NGO-managed camps are more represented in the random sample in this study, 33 percent.

For example, while the overall percentage of camps with water provided was 57.7%, the percentage is much higher (88.5%) in camps with an NGO management agency than those without (40%). The same is true of health care; whereas one in five camps overall had an onsite clinic, NGO-managed camps had twice that number (37.5%) while non-managed camps had half (11.1%). In overall conditions, on a scale from 1 to 10, with one being best, assistants assigned a mean of 5.1 for NGO managed camps and 6.4 for non-NGO managed camps. This isn’t perfect, as one of the worst (10) managed camps, Place de la Paix in Delmas 2 noted above, has an NGO camp management agency.

While there is indeed some hope in this finding that NGO management agencies appear to make a difference in services provided to the residents, the question must be asked as to why the vast majority of camps – four in five – do not have a management agency. OIM staff said that despite the information diligently collected about services or lack thereof, they have no mechanism to force NGOs to become camp management agencies. “It’s a thankless job,” said one. That said, there is clearly much more work to be done, particularly in areas typically underserved by NGOs. An NGO that is among the most visible and hard-working in Cité Soleil bristled at being listed as camp manager for fear of the communication of public responsibility that this designation connoted. “Others are just plain lazy,” said a development agency official on condition of anonymity.

Municipality

“Maybe it’s because we’re hidden away inside that the NGOs have forgotten us, but we’re the area that is most affected! This area, Fort-National and Pivoine, doesn’t have a big road so the NGO trucks just don’t see us. Maybe they just don’t see us.” – “Ti Georges,” camp committee leader in Pivoine.

There are definitely geographical differences in the services offered. For example, the percentage of camps with water is greater in the central cities of Delmas, Port-au-Prince, and Pétion-Ville, where the NGOs and the UN are headquartered. 83 percent of the camps in Delmas had water, whereas only 29 percent of camps in Croix-des-Bouquets and 25 percent in Carrefour had water.[11] It is possible that Carrefour residents have better access to CAMEP, the public water facilities or the sources. But it is consistent with the other findings. Simply put, Carrefour is farther away, with many camps off the main highway. Camps in Carrefour are also less likely (10.5%) to have a children’s play space than average (18.8%), to say the least about Pétion-Ville (33.3%).

Olga Ulysse, leader within the CAJIT camp, recalled: “People make appointments and they don’t come. I don’t know if it’s too far or if people are afraid of the mountain.” Her colleague Madame Odrigue, who is an elected member of the community council, the official local government, had another theory: “It’s because the donors don’t get credit for giving us water, unlike down the hill next to the Route National.”

This geographical difference in services is most noticeable in Cité Soleil, Port-au-Prince’s largest and poorest shantytown. None of the camps in Cité Soleil had a school, a canteen, a children’s recreational center, or a space that adults can use for committee meetings or other programming. Cité Soleil is far underserved because NGOs are afraid to, or don’t want to, work there. WASH and the IOM have a close collaboration in Cité Soleil, “but we can’t do more than push. The NGOs would rather work in the less badly hit, wealthier suburb of Petion-Ville (also close to their offices) rather than where the greatest need is,” decried the Cité Soleil IOM officer, who correctly predicted that this data would show a much lower rate of coverage in his area.

The situation of duplication in Bobin, which in the end meant that both NGOs dropped it, would never have occurred in Cité Soleil. “I can barely get the NGOs to come visit Cité Soleil, Delmas 2, Bel-Air, etc. Some say that they can’t. Some say that their car rental insurance won’t cover it. Some say they are legally prevented. In any case, these are the areas of greatest need.” Feast or famine, the problem is the same: lack of NGO coordination and the Haitian government’s inability to mandate coverage.

As, of course, is the result.

Camp Size

Size matters in the camps, a combination of this issue of NGO visibility and the refrain that people are only staying in camps to get services, and therefore cutting services will spur people on to rebuild their homes. Smaller camps (those with 100 or fewer families) receive far less services than larger ones. OIM and other humanitarian agencies began talking about a phenomenon of “ghost” (shrinking and disappearing) camps, particularly since April, after the general food distribution stopped. One humanitarian was quite direct to IAT: “if the camp doesn’t have more than 150 people, it doesn’t exist according to IOM.”

For example, camps with more than 1,000 families were more likely to have water (67%) than the overall average, whereas camps with 100 or fewer families were far less likely to have water – only 30%. The percentage of small (100 or fewer families) camps that had a clinic onsite was far smaller (6.3%) than average (19%), and certainly than large (more than 1,000 families) camps (58%). In addition, small-to-medium camps (up to 200 families) were also under-serviced: none in the sample had a clinic. Small camps were also less likely to have a children’s play space (6.3, compared to 18% average), and large camps were also much more likely to have psycho-social centers (58 percent, compared to an average of 16%).

People’s top priority – especially people having to keep all their belongings in a tent that can rip or be ripped, offering only the most minimal protection from the hot Caribbean sun and the tropical rain storms that have been battering the island – is to be moved into their old house, or a permanent house. That’s why people choose to stay in a small, “spontaneous” shelter close by their old home, where their social ties, friends, families, churches, school, business, street commerce, etc. remain.

Landowner

Among other things, the earthquake destroyed walls that protected private property, such as the Pétion-ville Club – a private golf club that became home to 30,100 people as of July. Desperately seeking shelter, this poses a fundamental conflict of interest: landowners’ right to their property and residents’ rights to decent temporary shelter and living conditions. Again on the belief that people are living in the camps because of the services provided, some private owners have cut off life-saving services, to get people to willingly leave the camps. NGOs and the UN “cannot interfere when the owner does not want us there,” said an official.

The result is that camps on public land have more services than those on private land. Camps that are on government land are more likely to have water (75%) than those on private land (51.8%).[12] The differences in health provision are more dramatic; 39 percent of camps on state land had a clinic, whereas only 12 percent of camps on private land did. Camps on public land were almost twice as likely to have a school (32%, compared to 17%). Among other issues there is also a significant difference regarding spaces for children to play (12 percent on private land, 27 percent on state land).

For example, the administration of the Saint-Louis de Gonzague school refused NGOs access to provide services. They stopped food distribution after the first time, and refused water. Resident leader Samuel Rémy argued that this withholding was an attempt to starve people out. “They know that we need food, clean water, latrines, and other materials. But we here have no choice but to stay here so we find what we need outside.” According to several neighborhood leaders, the school director kept the Red Cross and Medecins Sans Frontières from providing services. One day we visited, a group of Cuban doctors sat sheepishly in the entrance, waiting for authorization.

Eventually half of the residents of Saint-Louis de Gonzague were moved to Carradeux, including Elvire, in April. But this situation of starving people out of services is far from unique: International Action Ties has documented at least five other locations where this same situation occurred (2010).

Recommendations

The conditions in the camps are violations of the 1.5 million IDPs’ (including 200,000 living outside the camps) human rights. To address them head on, not only immediate action is needed, but so is a re-orientation of aid. Aid and reconstruction efforts should be based on a rights-based framework (see, for example, NYU School of Law Center for Human Rights and Global Justice 2008).

Now is the opportunity to rethink and retool the aid that has contributed to Haiti’s extreme vulnerability while rendering Haiti poorer and more dependent. The neoliberal framework is a collusion of local elite exclusion of Haiti’s poor majority and the exclusion of the Haitian state by forced privatization and a diminished social safety net.

Recommendation #1: Donors such as the U.S. and U.N. should focus more funds and rebuilding efforts at rebuilding the capacity of the elected Haitian government, and not simply NGOs.

The first lesson to learn from the camps is that the neoliberal attachment to NGOs must be critically rethought. As scholars of NGOs have long argued, they are not and never were the “magic bullet that can be fired in any direction and will still find its target” (Edwards and Hulme 1996:3). NGOs are just as likely to fall prey to the ills that befall elected governments: mismanagement, inefficiency, and corruption. Worse, as the experience in the camps shows, NGOs spend more money than Haiti’s government and are not even juridically responsible or accountable to the local population. The patchwork of services provided and the quite significant variability derives from their structure: they are private and “voluntary.”

It is not by coincidence that the cluster that has the most hands-on, local, empowerment-oriented approach and the most effective at attaining its results is the WASH cluster. It is also the only one headed by a Haitian government agency.

Recommendation #2: All NGOs working in Haiti need to work with the Haitian government and respect the local authorities.

In addition to the WASH cluster, and one of the ingredients of its success, is an array of effective local governments, such as Carrefour’s Mayor Jerome. Jerome is correctly respected among the donors for his “can-do” and hands-on approach, brokering agreements between land owners and residents; unlocking sticky land tenure issues; and making progress towards permanent housing and road reconstruction.

Recommendation #3: As a sector, NGOs must commit to managing more IDP camps

The data is clear; while only one in five camps had a Camp Management Agencies, it is clearly significant for camp conditions, noted above.

Recommendation #4: The U.N. must come clean on the issue of cholera.

Following the initial observations by the Centers for Disease Control, there should be an independent inquiry into the cause and spread of cholera. The U.N. as a whole and all units need to respond with respect, not self-protection. It is only through ‘coming clean’ and apologizing that productive engagement with the body, already weakened by the six-year military occupation, will be possible. This apology should come with additional resources for survivors and for prevention.

Recommendation #5: Provide services in the neighborhoods as well as the camps.

Given the persistent, and lethal, refrain that people are swelling the camps in order to receive aid, most critically water, punishing people who have nowhere else to go by withholding the services is both morally reprehensible and a violation of IDPs’ human rights.

Especially if this is true in a minority of cases, the more humane, just solution would be to provide these life-saving services to communities outside in addition to the camps. This might well be an incentive to encourage more people to move into permanent housing.

Recommendation #6: All parties: the Haitian government, NGOs, and donors, need to make the expedient construction of high-quality permanent housing its first priority.

Especially as they are being starved by the private landowners and NGOs alike from necessary services, increasingly people remain in IDP camps because they have nowhere else to go. Closing camps may be thought of as a “success” for policymakers and donors but this merely means that people are forced to once again relocate, moving farther away from their social network, economic opportunities, support systems, and children’s schools. The author has spoken with several people who were living in their third or fourth IDP camp as of mid-August, only seven months following the earthquake.

There are indeed several obstacles getting in the way of rebuilding housing, including rubble removal – an estimated 98 percent of the rubble remains.

For individuals who do have relatively secure land title and a house that can be rebuilt or repaired, the most just and expedient solution is to subsidize individual families to clear the rubble and make their own repairs. One NGO is attempting this to facilitate the closure of a 50-family camp. This is too new to be evaluated, but this grassroots approach should be explored more often and fully supported.

Recommendation #7: Fully fund Haitian relief efforts.

Progress on all of the above is stymied by the slow delivery on promised aid.

In a September 28 AP article, Jonathan Katz cited that only 15 percent of promised funds have been released (2010b). This was later confirmed by the Office of the Special Envoy’s September 30th report. Disturbingly, none of the promised 1.15 billion in aid from the U.S. has materialized. According to Katz, Senator Tom Coburn has blocked its passage in the Foreign Relations Committee because of a $5 million line-item that appears to duplicate the structure of the U.S. Ambassador in Haiti (ibid.). Quick action must be taken to rectify this while Congress is still in session, before they break for mid-term elections.

Katz, Jonathan. 2010a. Billions for Haiti, A Criticism for Every Dollar. Associated Press, March 6.

Ibid. 2010b. Haiti Still Waiting for Pledged US Uid. Associated Press, September 28.

Kristoff, Madeline. 2010. Haiti: the Republic of NGOs? U.S. Institute of Peace.

Morton, Alice. 1997. Haiti: NGO Sector Study. World Bank.

NYU School of Law Center for Human Rights and Global Justice, ; Partners in Health, ; RFK Memorial Center for Human Rights,; Zanmi Lasante. 2008. Wòch Nan Soley: the Denial of the Right to Water in Haiti Center for Human Rights and Global Justice, NYU School of Law.

Oliver-Smith, Anthony. 2010. Haiti and the Historical Construction of Disasters. NACLA Report on the Americas 43(5):32-36.

Smith, Jennie Marcelle. 2001. When the Hands are Many: Community Organization and Social Change in Rural Haiti. Ithaca: Cornell University Press.

The LAMP for Haiti Foundation, et al. 2010. “We Have Been Forgotten” – Conditions in the Camps Eight Months after the Earthquake. LAMP et. al.

Mark Schuller is Assistant Professor of African American Studies and Anthropology at York College (CUNY). In addition to understanding contemporary Haiti, Schuller’s research contributes to globalization, NGOs, civil society, and development. Schuller has published a half-dozen peer-reviewed articles and book chapters about Haiti in addition to several articles in public media including Counterpunch, Common Dreams, and the Center for International Policy and media interviews, including Democracy Now! He co-edited Capitalizing on Catastrophe: Neoliberal Strategies in Disaster Reconstruction(2008, Alta Mira) and Homing Devices: the Poor as Targets of Public Housing Policy and Practice(2006, Lexington). Schuller is also co-producer and co-director of documentary Poto Mitan: Haitian Women, Pillars of the Global Economy(2009, Documentary Educational Resources). He chairs the Society for Applied Anthropology’s Human Rights and Social Justice Committee and is active in a range of grassroots efforts, including earthquake relief.

Acknowledgements

The author would like to thank the State University of Haiti, in particular the eight student research assistants (Jean Dider Deslorges, Mackenzy Dor, Jean Rony Emile, Junior Jean Francois, Robenson Jean Julien, Rose Mercie Saintilmont, Castelot Val, and Jude Wesh) and colleague Chevalier Smail at the Faculté d’Ethnologie. Support for this research was provided by the Professional Staff Congress-CUNY and the CUNY Haiti Initiative. Tania Levey provided useful help with SPSS.

Notes:

[1] See http://www.haitireconstructionfund.org/hrf/members for disbursement figures.

[3] There were others, including attempts at reoriented Haiti’s peasant economy into global export, consolidating power in large-holding peasants and requiring foreign-produced fertilizers that were maladapted to the Haitian soil and other high inputs like labor and water.

[4] This May 3 database was the first listing on the website, “list of sites,” as of July 23.

[9] After objecting to Parliament’s unanimous bill raising Haiti’s minimum wage to 200 gourdes ($5) per day in the summer of 2009, President Préval suggested 125 gourdes ($3.12).

[10] The use of the term “aid” varies from person to person. For example, some consider water to be aid while some do not, reserving the term for food distribution only.

[11] Regrettably the assistant who primarily worked in Cité Soleil was not present when each camp was discussed (given the questionnaire there was an issue of coding), there were only two valid responses. But consistently Cité Soleil is far below average on every other indicator.

[12] The data set was too small to be statistically significant for camps on schools or churches for analysis.